CORRECTION OF PELVIC OBLIQUITY IN NEUROMUSCULAR SCOLIOSIS WITH A SACRAL-ILIAC SCREW CONSTRUCT

Abstract

Introduction: Pelvic obliquity is a constant problem in neuromuscular scoliosis. Galveston and Luque L rod techniques are well described and achieve good correction of pelvic obliquity. We describe a sacral and iliac screw construct integrated with double-rod, pedicle screws and hook system, for correction of pelvic obliquity.

Method: 44 patients underwent posterior or combined anterior and posterior fusion to pelvis, for correction of neuromuscular scoliosis and pelvic obliquity. Average age at the time of surgery was 13.8 years. All patients were wheelchair-bound and nine of them were therapeutic walkers. Average follow-up was 44 months (range 24–69 months). Twenty-six patients had combined anterior and posterior surgery. All patients had posterior instrumentation to pelvis and 18 had anterior instrumentation as well. Eighteen patients had posterior instrumented fusion alone. Anterior instrumentation (when used) was Synergy and posterior instrumentation was Synergy or Colorado for all patients.

Result: Average time for surgery was 5 hours and 20 minutes and average blood loss 3600 ml. The average pre-operative Cobb angle was 69° and pelvic obliquity 23°. Post-operative average Cobb angle was 29° and pelvic obliquity 7.5°. At the latest follow-up the average Cobb angle was 36° and pelvic obliquity 10°. There were three deep wound infections. Two of the sacral screws have become prominent and two patients had de-linking of the iliac screw with the rod on one side. None showed significant loss of correction.

Conclusion: The sacraliliac screw construct with double rod segmental instrumentation achieved good correction of pelvic obliquity in patients with neuromuscular scoliosis. Implant related problems were infrequent